It might seem too simplistic to equate old people with old cars, but the comparison is a valid one. Everything ages. It is the accumulation of damage that we incur simply by being here. As with cars, our bodies break down with time, not because of any manufacturing defect, but due to wear and tear. The damage suffered by our biological machines over the years, makes them liable to break down even at normal, moderate levels of use. Such appliances are simply old and in need of repair.
Charles Darwin understood this. From a biological perspective, there is no reason for us to get old. Humans need to reproduce and care for their children, so that they – in turn – can reach maturity and produce offspring of their own. It is not us but the DNA, the blueprint for our bodies that creates an “eternal” life cycle, something that Darwin called fitness. Therefore we are all subject to strict biological programming to conceive, bear, and raise children. And of course to have sex.
Around age 40 to 50, our body begins to deteriorate. Permanent strains and greying hair are just the beginning, soon followed by glasses and hearing aids. Women become infertile, and other losses in function leaves us needing pacemakers and hip replacements.
All this biological degradation happens as our useful life is over, at least in the evolutionary sense. Darwinian logic is no different than economy; it is much more profitable to invest available resources in youth and sex than keeping up repairing bodies that will ultimately fail.
A more self-determined life
A cardiologist once told me that in old age “our bodies simply rot”, but this is an untruth. Swift progress in medicine and technology means that thinking of aging only in terms of the biological is increasingly outdated.
From the 16th century, a popular motif in engravings was the “Ages of Man”, where the stages of a man’s life were represented on a rising and descending staircase, charting the chronological ascent from birth to a climax at the prime of life, and then descent towards eventual death. Men were depicted at the apex of their career at 50, while women were already sidelined by 30. For a long time this calendar age bound the aging process, health, and social standing together.
But chronological, biological and social age are now becoming increasingly uncoupled. Sex and reproduction, that until recently had been directly linked to chronological and biological age, has now become a matter of choice. The contraceptive pill gave both women and men the power to choose whether and when sex should lead to reproduction. At the other side of the spectrum, IVF now allows women to have children at an age that was previously impossible. After having frozen some of your eggs you could even think of deferring your pregnancy till postmenopausal age.
We now have more time. In developed countries we’ve already doubled our lifespan from 40 to 80 years, have increased our odds of reaching retirement to 9:10 , and when we retire there is still another 20 years to go. Our sequential development may be genetically fixed, but aging is not programmed and actually unfolds more erratically.
Every day we are getting better at finding ways to prevent and repair damage. We can now lower blood pressure and cholesterol with medication such as statins if your genes have endowed you with too much of it. Think of the quick fix when the cardiologist reopens your coronary arteries when you suffer an alarming pain in your chest and prevents tissue death from a lack of oxygen.
All these modern mechanics not only prevent you from dying off early, but also prevent your organs from dysfunction and keep your performance better for longer.
It is now that 75 is the new 65, not only in terms of life expectancy but also the functional capacities of our bodies. The certainty that most of us will reach old age with well-functioning bodies should unshackle us from the stages of life that have helped structure our societies in the past, but are now completely outdated.
Why nervously rush our children through the educational systems when they are most likely to become a centenarian? Many of us have a strong desire for a more self-determined and individualized life trajectory. Never before has fiction and reality come so close. Fertility, health and age have at least in part, become disconnected from each other. This asset however, is too little exploited so far.
While we may appreciate an explosion of life, we still don’t have a clue what to do with it.
Professor Rudi Westendorp was trained at the Leiden University Medical Centre (LUMC) in the Netherlands, and specialized in intensive care and epidemiology. Later, he focussed on geriatrics and gerontology. In 2000, he was appointed professor of medicine, and, from 2005 to 2012, he was head of the Department of Gerontology and Geriatrics at the LUMC. In 2008, he founded and became the first director of the Leyden Academy on Vitality and Ageing, a research institute that provides training, conducts research, and initiates developments in the field of vitality and ageing. In addition, since 2012, he has been director of the VITALITY! programm, part of Medical Delta, an innovative partnership of academic and public institutions, and enterprises, in the south-west of the Netherlands. In 2015, he moved his workplace to Denmark, where he was appointed Professor of Old-Age Medicine at the University of Copenhagen.
Rudi Westendorp (1959) studied medicine at the Leiden University, became a consultant in intensive care medicine and epidemiology, and in a later stage dedicated himself into geriatrics and gerontology. In 2000 he was appointed full professor at the Leiden University Medical Center and became chair of the department of old age medicine. As such he acquainted and successfully executed ample national and European grants, published more than 600 original articles with an h-index of 70+, and supervised over 50 PhD students of which three of them have been appointed full professor. Since 2007 he became the founding director of Leyden Academy on Vitality and Ageing that conducts research, provides education and pursues societal innovations to advance the quality of life of older people. From 2012 he chaired the VITALITY! program of Medical Delta, a consortium of the universities and municipalities of Leiden, Delft and Rotterdam. He was endowed doctor honoris causa by the University of Newcastle, UK (2009), and received a knighthood in the order of the Dutch Lion (2014). From 2015 onwards he moved office to Copenhagen University, Denmark at which he is appointed professor of Medicine at Old age at the Faculty of Health and Medical Sciences.
This article previously appeared here, republished under creative commons license.